Medical Underservice and Cancer Mortality Among Farmers in Illinois

A dominant theme in rural health care delivery has been the relative unavailability of physician services in rural areas. Although a nearly five-fold difference in physician to population ratio exists between urban and rural areas, little is known regarding the impact of this difference on health status. This epidemiologic study explores the potential impact by comparing standardized cancer mortality ratios (SMRs) among rural populations in a metropolitan county in Illinois with health care readily available within its boundaries to rural populations in two nonmetropolitan, medically underserved counties in the state. Four rural populations formed the study groups: (1) farmers in the metropolitan county; (2) rural nonfarmers in the metropolitan county; (3) farmers in the underserved counties; and (4) rural nonfarmers in the underserved counties. The entire population of the metropolitan county served as the standard population. Cancer was chosen as the disease entity of interest because past research has demonstrated excess mortality among farmers for certain cancer types and because successful detection and management of the disease requires extensive contact with the health care delivery system. As expected from past research, farmers in the study groups exhibited excess mortality for the leukemias and lymphomas, two cancer types thought to be associated with farm chemical exposure. Rural nonfarm populations evidenced decreased risk of mortality for most cancer types. In comparing the nonfarm study groups, the only statistically significant difference was an increased risk for prostate cancer in the metropolitan county. This finding suggests that barriers posed by medical underservice may not be as formidable as is sometimes thought. Although no single cancer type was significantly different between the two farm populations, the SMRs for farmers in the underserved counties were uniformly higher, leading to a significant difference in the SMR for all cancers combined. This finding suggests that medical underservice may have a small but incremental negative impact on cancer mortality among medically underserved farm populations. At 15% of the rural population of United States, farm residents may represent a sizeable and unexpected minority vulnerable to the impact of medical underservice.

Name thesis:degree_name

Ph.D.

Level thesis:degree_level

Dissertation

Discipline thesis:degree_discipline

Sociology

Grantor

University of Illinois at Urbana-Champaign

Year dc:date

2014

Author dc:creator

• Buesching, Don Paul

• Health Sciences, Public Health
• Sociology, Public and Social Welfare

Identifier

(UMI)AAI8610909

OAI identifier oai:identifier

oai:www.ideals.illinois.edu:2142/71011